Healthcare Provider Details

I. General information

NPI: 1821772484
Provider Name (Legal Business Name): RACHEL OTTO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL BUKER

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9540 N GARNETT RD STE 101
OWASSO OK
74055-4410
US

IV. Provider business mailing address

9070 W CHEYENNE AVE STE 100
LAS VEGAS NV
89129-8935
US

V. Phone/Fax

Practice location:
  • Phone: 918-609-1300
  • Fax: 918-609-1318
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6408
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: